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When fluid therapy is not successful in reversing a shock state, adrenergic agents are used, most commonly dopamine or norepinephrine. These agents differ in their modes of action, as they affect α-adrenergic and β-adrenergic receptors differently. Observational studies have shown higher death rates with dopamine than with norepinephrine in patients with shock; the few randomized trials to date have been too small to provide meaningful data.
In the current multicenter European study, 1679 adult patients with shock (signs of tissue hypoperfusion and systolic blood pressure <100 mm Hg or mean arterial pressure <70 mm Hg) that persisted after treatment with “adequate” fluids (at least 1000 mL of crystalloids or 500 mL of colloids) were randomiz…